Keeping Patients HIV-Free

Through providing easy access to medication, fostering community, and offering telehealth opportunities, Kaiser Permanente Northern California is keeping members free from HIV. Pictured above, Truvada, a pill used to reduce the risk of getting HIV.

At Kaiser Permanente Northern California, thousands of members are benefiting from a focused effort to prevent HIV, mainly through preexposure prophylaxis (PrEP), a daily pill that prevents acquisition of the HIV infection.

“In clinical trials, PrEP reduces the risk of getting HIV from sex by more than 90 percent, and the experience of PrEP use at Kaiser Permanente Northern California suggests that real-world effectiveness may even be much higher than this,” said Jonathan Volk, MD, MPH, physician and epidemiologist at Kaiser Permanente San Francisco. “The fact that we have seen zero new HIV infections among our thousands of patients actively using PrEP highlights how well this medication works when taken.”

Kaiser Permanente Northern California also encourages condom usage in addition to taking PrEP, as condoms help further reduce the risk of HIV and protect against sexually transmitted infections (STIs).

Kaiser Permanente Northern California introduced PrEP, commercially known as Truvada, as a viable option to reduce the risk of contracting HIV almost immediately after the U.S. Food and Drug Administration approved its use in 2012. PrEP is for people who are HIV-negative but at high risk for getting HIV from condomless sex or unsafe injection drug use practices.

How the PrEP Program Works

Members interested in taking PrEP can talk to their Kaiser Permanente primary care physician to get a referral or can self-refer directly to a PrEP-knowledgeable specialist.

Once a member is taking PrEP, the person needs to get quarterly blood tests to check kidney function and for HIV. On the same visit to the lab, patients can self-collect throat and rectal swabs to test for STIs. This self-collection allows patients to get their PrEP follow-up without needing to schedule an in-person appointment. The Kaiser Permanente labs are open on weekends, evenings, and holidays, making it easy and convenient for patients to come in and get the care they need. Patients’ results are then viewable online.

“For the vast majority of our patients, PrEP is tolerated with few or no side effects. It is an incredible tool that we can use to prevent new HIV infections,” said Dr. Volk. “Notably, PrEP is just one of many HIV prevention strategies now available, which also include condoms and making sure our HIV-infected patients are diagnosed and getting treatment.”

“We provide opportunities for self-collection for STIs, allowing autonomy for our members, and telehealth alternatives to in-person visits. Patients can communicate with their providers at their convenience over secure email or through telephone calls, instead of having to frequently come in for visits that can be challenging to schedule,” said Dr. Volk.

Kaiser Permanente is also leveraging technology to help PrEP patients. Specialized tools on Kaiser Permanente’s computer system allow for effective population management: keeping track of patients who haven’t picked up their medication, are behind on labs, or need additional support or targeted outreach.

‘It Makes Me Feel and Be Safe’

Paul Marcelin has been a Kaiser Permanente member for more than 20 years. A longtime community activist who has led seminars about HIV prevention and currently volunteers on an advisory group for prevention research, Marcelin started taking PrEP in July 2013, once it became widely available. His boyfriend is HIV positive and “undetectable,” meaning that he has no detectable virus in his blood because of his HIV medications; individuals who are HIV-infected and undetectable have a negligible risk of transmitting the infection.

“Kaiser Permanente is night and day ahead of other private providers in terms of HIV prevention,” said Marcelin. “It’s one insurer, one provider, one organization. It’s an integrated system that understands the importance of being open to discussing PrEP, its benefits, and its use.”

Marcelin wanted to thank the staff at Kaiser Permanente San Francisco Medical Center, where he receives his care.

“Amazing people work there and they make me feel and be safe. The PrEP program is reducing fear, and people are less afraid to be intimate.”

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Discussion2 Comments

Good article highlighting this effective treatment for preventing HIV. The problem for my patients is that the co-pay is sometimes prohibitively high. Recently I was working with someone who makes less than $42,000/year and his co-pay for Truvada is $50. He can’t afford it. There’s some concern MFA, which he qualifies for, will not pay for it. Can anyone clarify that? Thanks.

Hi, Claire, thanks for writing in! I spoke with Dr. Volk, and this is his resposne to your question:

“In regards to the cost, there is a copay assistance program from Gilead that will reimburse 3,600/yr for copays. It does not cover labs, unfortunately. No income restrictions, so pretty much all of our patients can access this (although there are few exclusions, like Medicare for our older patients. We have hundreds of patients who use this, so the medicine is free for most/all of our patients. Patients need to pay for the medication at our pharmacy, and they can then send receipts directly to Gilead for reimbursement. At other non-Kaiser Permanente pharmacies, the copay card will allow patients to get medication for free (if < 3600/yr), and the pharmacy will then get the reimbursements from Gilead themselves. Our pharmacy, however, does not share any patient information directly with the drug companies, so it adds the extra step of needing to pay for the medications and then getting reimbursed from Gilead later."

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